Beyond Necrotizing Enterocolitis Prevention: Improving Outcomes with an Exclusive Human Milk–Based Diet

Abstract

Objective: The aim of this study was to compare outcomes of infants pre and post initiation of a feeding protocol providing an exclusive human milk–based diet (HUM).Materials and Methods: In a multicenter retrospective cohort study, infants with a birth weight <1,250 g who received a bovine-based diet (BOV) of mother's own milk fortified with bovine fortifier and/or preterm formula were compared to infants who received a newly introduced HUM feeding protocol. Infants were excluded if they had major congenital anomalies or died in the first 12 hours of life. Data were collected 2–3 years prior to and after introduction of an exclusive HUM diet. Primary outcomes were necrotizing enterocolitis (NEC) and mortality. Secondary outcomes included late-onset sepsis, retinopathy of prematurity (ROP), and bronchopulmonary dysplasia (BPD).Results: A total of 1,587 infants were included from four centers in Texas, Illinois, Florida, and California. There were no differences in baseline demographics or growth of infants. The HUM group had significantly lower incidence of proven NEC (16.7% versus 6.9%, p < 0.00001), mortality (17.2% versus 13.6%, p = 0.04), late-onset sepsis (30.3% versus 19.0%, p < 0.00001), ROP (9% versus 5.2%, p = 0.003), and BPD (56.3% versus 47.7%, p = 0.0015) compared with the BOV group.Conclusions: Extremely premature infants who received an exclusive HUM diet had a significantly lower incidence of NEC and mortality. The HUM group also had a reduction in late-onset sepsis, BPD, and ROP. This multicenter study further emphasizes the many benefits of an exclusive HUM diet, and demonstrates multiple improved outcomes after implementation of such a feeding protocol.

Human milk as a protective factor for bronchopulmonary dysplasia: a systematic review and meta-analysis

“…There were 17 cohort studies21–26 30–38 40 41 and 5 RCTs 20 27–29 39. The sample sizes varied from 5230 to 158721. Most of the BPD diagnostic criteria were oxygen dependency at 28 days or more after birth or 36 weeks postmenstrual age (PMA),20–25 27–29 31 33 35 36 38–41 pulmonary radiography20 and chest X-ray24 abnormalities, and prolonged mechanical ventilation30; however, the definition of BPD in the four studies was unknown 26 32 34 37…”

Own mother’s milk significantly decreases the risk of bronchopulmonary dysplasia

“…Despite various strategies aimed at decreasing BPD, the incidence remains high for premature infants. In a recent retrospective multicentre study, an exclusive human milk-based diet was shown to decrease the incidence of BPD, NEC, retinopathy of prematurity and death 3. Patel and colleagues’ study is the first to evaluate the impact of OMM on the risk of BPD and associated costs.…”

Influence of own mother's milk on bronchopulmonary dysplasia and costs

“…[14][15][16] However, investigations of the impact of human milk (OMM±donor milk supplementation) on BPD are limited. [17][18][19] The purpose of this study was to investigate the dose-dependent impact of OMM feedings received from birth to 36 weeks PMA on BPD and associated NICU healthcare costs in a contemporary cohort of VLBW infants.…”